by urban-acupuncture | Jul 1, 2016 | Acupuncture
Menopause Treatment Options
Natural menopause for women generally occurs between the ages of 45 and 56. The on-set of menopause means that the reproductive hormones can no longer function naturally. These changes in hormones come with a degree and variety of side effects. Experts at Acupuncture of Columbus, Ohio and elsewhere believe that acupuncture can prove to be quite effective in treating menopause.
Noted side effects and symptoms
Leading a regular and normal life becomes quite difficult for some women going through menopause. Between 15% and 60% of menopausal women visit their local medical practitioners with complaints of a variety of symptoms. The most commonly reported symptoms include hot flushes, night sweats, palpitations, insomnia and so on. The other very common complaints sited comprise of anxiety, depression, lethargy, vaginal dryness, urinary and other genital problems, aches and pains, and many more.
Treatment
The most common and traditional form of treatment is usually hormonal replacement therapy (HRT). But most women do not prefer this conventional form of treatment as it usually continues for years. Some women are even unwilling to or are advised against this treatment because it may have very disturbing side effects. As a result, most women resort to acupuncture to help them cope with the symptoms of menopause.
According to research carried out on the specialist acupuncture database, ARRCBASE, at least 30% of the women who opted for acupuncture are aged between 40 and 59. The effects of acupuncture on the hormones circulating in the blood are somewhat similar to the hormone replacement therapy.
The Study
In trials carried out on menopausal women with very distressing symptoms, it has been found that acupuncture often leads to an increase in other hormones such as thyroid stimulating hormone (TSH), testosterone, and cholesterol. Those women treated with electro acupuncture reported a decline in hot flushes by more than 50%. Some even confirmed complete disappearance of most of the symptoms.
Improvements in physical discomforts were seen in nearly all cases. There was an appreciable amount of improvement in the overall psychological well being as well. In most cases anxiety and depression could be treated perfectly.
It has also been found that, like HRT, the effects of acupuncture eventually wear off. There is a 13% chance of a recurrence in symptoms. In order to maintain the therapeutic benefits of acupuncture, monthly treatments are necessary.
Conclusion
The studies carried out by a team of experts and a research of the composite database built by Acupuncture Research Resource Centre (ARRCBASE) has determined that acupuncture therapy is indeed beneficial in reducing certain menopausal symptoms such as hot flushes, depression and anxiety. The best part of treating menopause with acupuncture is that individuals can receive tailored treatment depending on their condition.
The studies carried out confirm that acupuncture has immense potential in treating anxiety, depression and other joint related troubles in menopausal women. But the studies carried out are not sufficient to prove this point. More research needs to be carried out to calculate the exact effectiveness of acupuncture in treating menopause.
Contact Us For More Information
For more information about how acupuncture, massage therapy and other alternative healing treatments can help you, please contact the Urban Acupuncture Center Board Certified Licensed Acupuncturist’s team at Indianola Ave, Clintonville (614) 725-2488 | Main St, Westerville (614) 426-4406 or click here. Taking new patients in and around greater Columbus, Ohio.
by urban-acupuncture | Jun 29, 2016 | Acupuncture
Arthritis Treatment
Acupuncture and Rheumatoid Arthritis may not sound like they go hand in hand. How is poking needles on your skin going to treat a disease of the joints? It sounds very uncomfortable. Doesn’t it? But you would be surprised to know that acupuncture actually helps to treat Rheumatoid Arthritis (RA).
In Columbus, Ohio, this therapy is gaining significant recognition as a reliever of pain from rheumatoid arthritis.
The process
Acupuncture involves the inserting of needles on to the skin at some of the 2,000 pressure points present on the body. The pressure of the needles restores absolute flow of energy in the body. Sometimes mild electric current is also used. This version of acupuncture is known as electro-acupuncture.
Rheumatoid arthritis is the swelling of joints of the hands and feet, especially the wrists and the knuckles.
Experts from the Center for Integrative and Lifestyle Medicine at Cleveland Clinic agree that acupuncture does relieve pain by increasing the release of endorphins, naturally produced painkillers by our own body. It relieves pain locally by having an anti-inflammatory effect on the swollen joints.
Study by Chinese researchers in 2011 proved that both the styles of acupuncture – electro and traditional – have significantly reduced chronic inflammation. Inflammation is generally caused by an increase in tumor necrosis factor-a (TNF-a) and vascular endothelial growth factor (VEGF). Acupuncture significantly reduces these two factors. TNF-a is the main culprit when it comes to joint damage. Rheumatoid arthritis is described by depletion of bones.
Director of the paediatric pain management clinic at Children’s Hospital in Los Angeles, Jeffrey I. Gold, PhD, asserts that acupuncture on specific areas of the body induce response in different parts of the brain. MRI scans have proved that acupuncture not only blocks pain signals but also has neurological, psychological, immunological and hormonal effects. But Gold also concedes that it is not yet clear how the inflammatory factor TNF-a is affected by acupuncture.
The 2008 version of Arthritis & Rheumatism have revealed that several tests conducted have confirmed that the practice of the therapy of acupuncture has led to a decrease in morning stiffness and other pain in patients of rheumatoid arthritis.
The various studies conducted also revealed that there has been considerable reduction in erythrocyte sedimentation rate (ESR) and also a significant reduction in C-reactive protein (CRP). Both ESR and CRP are factors that cause swelling of the joints in the hands and feet.
Ideally, treatment takes around three to six sessions.
Limitations
Acupuncture may not be effective on everyone. 20% of the patients may not get the desired results. The reason could be that there are different types of acupuncture and different practitioners have different styles of practicing this therapy. Also, certain insurance companies may not cover acupuncture therapy.
Proper research needs to be done before deciding on an acupuncture practitioner. Licensed acupuncturists with experience of treating RA patients should only be considered.
Though much research needs to be done into the actual effect of acupuncture on RA, the evidence actually looks very promising. If you suffer from Arthritis and want to know your treatment options, get in touch with Acupuncture of Columbus today.
For more information about how acupuncture and other treatments can help you, please contact Board Certified Licensed Acupuncturist, Steve Drugan,B.S., L.Ac., at 614.218.6287 or click here. Taking new patients in and around Columbus, Ohio.
by urban-acupuncture | Jun 11, 2016 | Acupuncture
What is Constipation?
Being constipated means your bowel movements are difficult or happen less often than normal. Almost everyone has it at some point in life, and it’s usually not serious. Still, you’ll feel much better when your system is back on track.
The normal length of time between bowel movements varies widely from person to person. Some people have bowel movements three times a day. Others have them only once or twice a week.
Going longer than three or more days without one is usually too long. After three days, the stool or feces become harder and tougher to pass.
What Are the Symptoms?
- Few bowel movements
- Trouble having a bowel movement (straining)
- Hard or small stools
- A sense that everything didn’t come out
- Swollen abdomen or abdominal pain
- Vomiting
Constipation Treatment
Treatment for chronic constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through your intestines. If those changes don’t help, your doctor may recommend medications or surgery.
Diet and lifestyle changes
Your doctor may recommend the following changes to relieve your constipation:
Increase your fiber intake. Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.
Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.
A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.
Exercise most days of the week. Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week.
Don’t ignore the urge to have a bowel movement. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.
Laxatives
Several types of laxatives exist. Each works somewhat differently to make it easier to have a bowel movement.
Examples of laxatives include:
- Fiber supplements. Fiber supplements add bulk to your stool. Common ingredients include methylcellulose, psyllium, calcium polycarbophil and guar gum. Brand names include FiberCon, Metamucil, Konsyl and Citrucel.
Stimulants.
- Osmotics. Osmotic laxatives help fluids move through the colon. Examples include milk of magnesia, magnesium citrate, lactulose, polyethylene glycol (MiraLax) and sodium phosphate enema (Fleet Enema).
- Lubricants. Lubricants enable stool to move through your colon more easily. One example of a lubricant is mineral oil.
- Stool softeners. Stool softeners moisten the stool by drawing water from the intestines. Examples include Colace and Surfak.
Alternative Treatments: Useful Acupuncture Points for Quick Constipation Relief
Stimulating these acupressure points with your fingers can help relax the abdomen and promote regular bowel movement without any pain or discomfort. They also help in relieving the associated symptoms of constipation such as abdominal pain, bloating and gas.
CV6
CV6 or Conception Vessel 6 is an important acupressure point for treating constipation. It is also named the Sea of Qi and this point is located exactly three finger widths below the belly button. This point should be stimulated using the fingertips gradually. The pressing should be no more than 1 inch deep. You will peel something firm with your fingers as you press. Maintain this firm pressure for 30 seconds as your breath normally keeping your eyes closed. This point helps in relieving pain in the abdomen, constipation, colitis and gas. It is also useful for treating hernia, irregular menstruation, impotence in men, digestive disorders and fatigue.
CV12
CV12 or Conception Vessel 12 is yet another vital acupressure point that is a solution for all types of digestive problems and provides quick constipation relief. It is known as the Center of Power and it can be found on the midline of the body, halfway between the base of the breastbone and the belly button. This point should be stimulated with great care and should not be pressed for more than 2 minutes at a stretch. It should be pressed on an almost empty stomach. It is best to avoid this point if you are suffering from heart disease, cancer or hypertension. It relieves constipation along with abdominal spasms, stomach pain, indigestion, heartburn and emotional stress. It is also an effective pressure point for dysentery, jaundice, insomnia and vomiting.
St36
St36 or Stomach 36 is a beneficial point of acupressure for constipation that relieves stomach and intestinal disorders, promotes digestion and strengthens the whole body. This is also known as the Three Mile Point and it is situated four finger widths below the kneecap, one finger width towards the outside of the shinbone. When you reach the correct spot, you will feel flexing of a muscle as you move your foot up and down. Use your palms to briskly rub this point for one minute on both legs. It is also a useful point for asthma, PMS, insomnia, depression and nervousness.
LI4
LI4 or Large Intestine 4 is by far the most famous acupressure point that is a solution for various health issues and is an important point for constipation acupressure. It is called the Joining Valley point and it is located on the fleshy muscle between the index finger and the thumb. Spread your thumb and in index finger apart and stimulate this point by squeezing the fleshy webbing with your fingertips for 1 minute while you take long, deep breaths. Now, switch sides and press the point on the other hand for 1 minute. It helps to relieve constipation, chronic pains, eye problems, toothache, and allergies and boosts the immune system. This point is forbidden for pregnant women because stimulating this point can lead to premature contractions of the uterus.
Contact Us For More Information
For more information about how acupuncture, massage therapy and other alternative healing treatments can help you, please contact the Urban Acupuncture Center Board Certified Licensed Acupuncturist’s team at Indianola Ave, Clintonville (614) 725-2488 | Main St, Westerville (614) 426-4406 or click here. Taking new patients in and around greater Columbus, Ohio.
by urban-acupuncture | Jun 1, 2016 | Acupuncture
What causes diarrhea?
Diarrhea may be caused by a temporary problem, like an infection, or a chronic problem, like an intestinal disease. A few of the more common causes of diarrhea are:
- Bacterial infections. Several types of bacteria, consumed through contaminated food or water, can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli.
- Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
- Food intolerances. Some people are unable to digest some component of food, such as lactose, the sugar found in milk.
- Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
- Reaction to medicines, such as antibiotics, blood pressure medications, and antacids containing magnesium.
- Intestinal diseases, like inflammatory bowel disease or celiac disease.
- Functional bowel disorders, such as irritable bowel syndrome, in which the intestines do not work normally.
Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon that can occur after gallbladder surgery.
In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.
When should a doctor be consulted?
Although usually not harmful, diarrhea can become dangerous or signal a more serious problem. You should see the doctor if any of the following is true:
- You have diarrhea for more than 3 days.
- You have severe pain in the abdomen or rectum.
- You have a fever of 102 degrees Fahrenheit or higher.
- You see blood in your stool or have black, tarry stools.
- You have signs of dehydration.
What is the treatment?
In most cases, replacing lost fluid to prevent dehydration is the only treatment necessary. Medicines that stop diarrhea may be helpful in some cases, but they are not recommended for people whose diarrhea is caused by a bacterial infection or parasite—stopping the diarrhea traps the organism in the intestines, prolonging the problem. Instead, doctors usually prescribe antibiotics. Viral causes are either treated with medication or left to run their course, depending on the severity and type of the virus.
Acupuncture to treat diarrhea
There are the acupressure points for relieving Diarrhea. Working on these points can help you get better quicker. You do not have to use all of these points. Using just one or two of them whenever you have a free hand can be effective.
- Points (A) — Abdominal Sorrow
Location: Below the edge of the rib cage one-half inch in from the nipple line. Benefits: Relieves diarrhea, ulcer pain, indigestion, appetite imbalances, and abdominal cramps.
- Points (B) — Sea of Energy
Location: Two finger widths directly below the belly button. Benefits: Relieves chronic diarrhea, constipation, and gas; strengthens the abdominal muscles.
- Points (C) — Three Mile Point
Location: Four finger widths below the kneecap, one finger width on the outside of the shinbone. If you are on the correct spot, a muscle should flex as you move your foot up and down. Benefits: Strengthens the whole body, tones the muscles, aids digestion, and relieves stomach disorders.
- Points (D) — Travel Between
Location: At the juncture of the big and second toes. Benefits: Relieves diarrhea, stomachaches, headaches, and nausea.
- Points (E) — Grandfather Grandson
Location: On the arch of the foot, one thumb width in back of the ball of the foot. Benefits: Relieves indigestion, diarrhea, stomachaches, and nausea.
It’s important to drink plenty of warm water after the massage, to help clear away toxic substances in our body.
For more information about how acupuncture and other treatments can help you, please contact Board Certified Licensed Acupuncturist, Steve Drugan,B.S., L.Ac., at 614.218.6287 or click here. Taking new patients in and around Columbus, Ohio
by urban-acupuncture | May 15, 2016 | Acupuncture
Ulcer Treatment
Until quite recently ulcers were thought to be one of the crosses hard-working executives had to bear. They were the mark of a striving go-getter, who strode from power lunch to stock-market take-over bid, pausing only to swallow a packet of antacid tablets. Normally, so the theory went, the stomach doesn’t digest itself because a coating of mucus protects it from the hydrochloric acid which, together with an enzyme called pepsin, breaks down the food. But stress and anger can increase the amount of acid in the stomach while aspirin and other drugs can reduce the protective mucus and so the acids begin to eat away at the walls of the stomach or duodenum, creating crater-like sores which can be very swollen and tender. Classic symptoms include burning, intense pain in the mid-upper abdomen, and waking in the early morning, often with a sensation of abnormal hunger.
Peptic ulcers are the most common type of ulcer in the gastrointestinal system and can cause stomach acid and severe pain. Other symptoms can include weight loss, decreased appetite and nausea. Aspirin and NSAIDS are commonly used to treat pain conditions but then easily cause peptic ulcers. Another major cause of peptic ulcers is the helicobacter pylori bacteria. The World Health Organization (WHO) endorses and recommends acupuncture in the treatment of peptic ulcers.
Clinical trials have demonstrated that acupuncture for peptic ulcer helps. Chinese herbs can also be used to treat peptic ulcers.
Most Common Ulcer Signs & Symptoms
- Abdominal pain – H. pylori can cause painful inflammation of the stomach and small intestine lining. Pain can also be caused by a build up of gases, and constipation.
- Heartburn – Also called acid reflux, or GERD. When acid is low, digestion of food becomes slow and difficult. The result is that food sits in the stomach too long and gives off gases which can cause burning sensations in the stomach and throat.
- Anemia – Or iron deficiency – this is closely linked with an H. pylori infection. When an H. pylori infection has caused low stomach acid, it becomes particularly difficult to digest protein (which contains iron).
- Mild Abdominal Discomfort – Typically felt 2 – 4 hours before or after meals
- Bad Breath – H pylori organisms present in stomach acid create ammonia, which results in bad breath.
- Chest Pain – When H. pylori infection causes an inflammation in the stomach, the pain signals from the stomach can reflex into the chest, shoulder blade and stomach areas
- Constipation – When H. pylori causes low stomach acid, food is not processed properly causing undigested food to be released into the intestine.
- Diarrhea – The diarrhea may only happen infrequently, or it may happen almost daily, depending on how chronic the infection of H. pylori is.
- Gastritis – Gastritis is characterized by an inflammation of the stomach lining. H. pylori uses it’s corkscrew shape to burrow into, and injure the stomach lining, which results in inflammation.
- Nausea & Vomiting – H pylori causes nausea, but the reason for this is not clear. It is thought that as the body attempts to rid itself of the infection, the ejection happens through the process of vomiting. These symptoms can sometimes be mistaken for morning sickness in pregnant women.
What causes peptic ulcer according the Chinese medicine?
According to Chinese medicine, there can be a number of causes of peptic ulcers. Sometimes the liver is the cause of the problem and it is mainly stress and irritability that that upset the liver. Traditional Chinese medicine theory views that when the liver is over worked from excess emotional turmoil such as anger and irritability, the pressure in the liver builds up. This pressure is eventually released and then attacks sideways and affects the stomach. The stomach is affected by the heat of the liver and this extra heat from the liver burns away at the stomach.
This is why patients find it strange that their acupuncturist has put in needles into acupuncture points on the liver meridian to treat their burning stomach pain.
Research has also shown that certain aspects of the tongue can change during the course of acupuncture and Chinese herbs. One such example, is the observance of purple veins underneath the tongue that became reduced as treatment progressed and the helicobacter pylori infections resolved.
Results for Ulcer Treatment with Acupuncture
Tests on patients who have undergone acupuncture treatment for stomach ulcers show that acupuncture procedures can normalize certain processes of the gastro intestinal tract. There is not much evidence available to show exactly how effective acupuncture is as a treatment for stomach ulcers caused by H. pylori. Acupuncture is a painless treatment with thin metal needles being inserted to varying depths, and at specific acupuncture points. The needles are usually left inserted for 15 – 30 minutes. Treatment normally involves multiple sessions over a period of weeks or months.
For more information about how acupuncture and other treatments can help you, please contact Board Certified Licensed Acupuncturist, Steve Drugan,B.S., L.Ac., at 614.218.6287 or click here. Taking new patients in and around Columbus, Ohio.
Illustration By BruceBlaus [CC BY-SA 4.0 , via Wikimedia Commons
by urban-acupuncture | May 11, 2016 | Acupuncture
What is Fibromyalgia (fy-bro-my-AL-ja)?
Fibromyalgia is a common and complex chronic pain disorder that causes widespread pain and tenderness to touch that may occur body wide or migrate over the body. Along with other symptoms, pain and tenderness wax and wane over time. Fibromyalgia (FM) affects people physically, mentally and socially. Approximately 10 million Americans (2-4%) have FM with a ratio of about 8 to 2, women over men. It occurs in people of all ages, including children. The literal translation of the word fibromyalgia is pain in the muscles, ligaments and tendons. But FM is much more than pain and presents with many other symptoms that vary from person to person.
Symptoms of Fibromyalgia
Chronic widespread body pain which can wax and wane is the primary symptom of fibromyalgia. Both men and women with fibromyalgia often experience moderate to extreme fatigue, sleep disturbances, sensitivity to touch, light, and sound, and cognitive difficulties. Many individuals also experience a number of other symptoms and overlapping conditions, such as irritable bowel syndrome,TMJD, lupus and arthritis. Stress often increases symptoms of fibromyalgia.
- Pain – The pain of fibromyalgia is profound, chronic and widespread. It can migrate to all parts of the body and vary in intensity. FM pain has been described as stabbing and shooting pain, with deep muscular aching, throbbing, and twitching. Neurological complaints such as numbness, tingling, and burning are often present and add to the discomfort of the person with fibromyalgia. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.
- Fatigue – In today’s world many people complain of fatigue; however, the fatigue of FM is much more than being tired after a particularly busy day or after a sleepless night. The fatigue of FM is an all-encompassing exhaustion that can interfere with occupational, personal, social or educational activities. Symptoms include profound exhaustion and poor stamina.
- Sleep problems – Many people with fibromyalgia have an associated sleep disorder that prevents them from achieving deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the Stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.
- Other signs, symptoms, and overlapping conditions – Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud’s Syndrome, neurological symptoms, and impaired coordination.
Fibromylagia Treatment
An estimated 3% – 6% of the American population suffers from the chronic disorder known as fibromyalgia, which causes widespread pain, fatigue, and even anxiety. The exact cause of the disorder is unknown, and its duration and intensity varies for each patient. For those living with it, it can be a life-altering condition, leaving them unable to enjoy activities that others take for granted. While there are many variations in the treatment of fibromyalgia, acupuncture provides a safe method which has been shown to greatly reduce the associated symptoms.
Although there is no known cure for fibromyalgia, a multidisciplinary team effort using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy and pharmacologic therapies have been shown to improve symptoms and function in patients with fibromyalgia. Helping patients to identify which combination of these therapies makes the most impact on their quality of life can be part of a successful symptom self-management system. Education is paramount to the success of this kind of protocol, both for healthcare professionals as well as the patient.
Among the benefits fibromyalgia sufferers stand to gain from acupuncture are:
- Reduced Pain
- Relaxation
- Improved Sleeping Habits
- Boosted Immune System
Additionally, other treatment methods may be applied to work in conjunction with acupuncture therapy. A well-rounded treatment plan is key to successfully treating the disorder. Rather than relying on medications such as pain relievers or antidepressants which alter brain chemistry, relief may be found in combining acupuncture with some or all of the following:
- Chiropractic Care – Fibromyalgia causes muscle tightness, discomfort, and a loss in mobility over time. Gentle chiropractic adjustments can help the muscles regain their pliability without causing damage.
- Cold Laser Therapy – Muscle tissue has been shown to have reduced healing capabilities in fibromyalgia patients. Cold laser therapy not only stimulates tissue healing, but decreases pain sensations as well.
- Exercise – Staying physically active is crucial for patients, allowing them to retain higher levels of comfort and flexibility. Aerobic exercise seems to be particularly helpful.
- Diet – Fresh and organically grown foods have less stress on the body, helping it function at its maximum capacity. A diet consisting of foods such as soy, nuts and berries, brown rice, and hormone-free chicken and turkey will be beneficial.
Fibromyalgia can be a frustrating and debilitating illness for the millions of individuals who struggle with it each day. It often leads to multiple doctors, different treatment plans, and a dependency on a range of pharmaceutical drugs. Thankfully, acupuncture can be a highly effective option, resulting in drastically reduced pain and fatigue for months at a time. Furthermore, when combined with complimentary therapies and appropriate lifestyle changes, it can mean a radical change in the quality of life for fibromyalgia patients.
Contact Us For More Information
For more information about how acupuncture, massage therapy and other alternative healing treatments can help you, please contact the Urban Acupuncture Center Board Certified Licensed Acupuncturist’s team at Indianola Ave, Clintonville (614) 725-2488 | Main St, Westerville (614) 426-4406 or click here. Taking new patients in and around greater Columbus, Ohio.
